When I was in training to become an IV therapist, I testified in a hospital hearing against a class mate who took me home for dinner and showed me drawers full of pills, needles and syringes she stole from the hospital. She was expelled from the program, but no criminal charges were filed. Shortly thereafter, she was arrested for palming physician prescription pads and writing prescriptions for controlled substances. Later as an employee at a large (over 1,000 beds) teaching hospital, I witnessed the arrests of two of my co-workers: one for diverting drugs and paraphernalia for street sale; the other for taking injectable painkillers, using them for herself, and substituting saline for the patients’ medications. Medications are better controlled now with inventory management, locked drawers sent down with blister-packed medications, bar coding and magnetic card access. However, a clever thief can find ways around almost any control system.
The good news is the shortage of public health workers, nurses and health care professionals in almost all categories and settings has been well communicated. The message of “You can get a job and make money” has been heard. The bad news is there are some people who did not hear “Do you want to help other people?” They heard “Do you want to help yourself?”
In 2008, I voiced my concerns about walking the talk in health administration (Buchbinder, 2008). I worried that health care managers, like Hannibal Lecter said in Silence of the Lambs, “covet what we see each day.” Health care managers see money and have access to financial data. A smart, but unethical person, can find a way to embezzle from health care organizations. A cursory search of the Internet using only health care and fraud gave me an unbelievable 23.7 million hits. And, it happens at every level, from the receptionist who steals cash co-pays, to the practice manager who deposits practice revenues into her personal account, to CFOs who play shell games with corporate finances.
One way to reduce the number of unethical people entering public health and health care is at the academic side of the pipeline: zero tolerance for lack of academic integrity; required compliance with codes of conduct and professional demeanor; serious interventions for red flag behaviors (sexual harassment, bullying of class mates and instructors)--and a requirement that professors and mentors walk the talk, too. Once the student graduates, their employers must be mindful of these same types of behaviors. However, one of the issues associated with unethical, illegal employee behaviors is that many organizations are loathe to prosecute, for fear of bad publicity. After all, who wants to be known as the hospital where the IV therapist was diverting drugs to the street? Employees who are let off without even a slap on their wrists are then free to move onto greener pastures. If the organization requires a criminal background check (and most do), the offender can present him or herself with a clean record, because there are no charges. This is a disservice to the public and to other employers.
Another way to reduce the number of unethical people in public health and health care is to address the practitioner side of the pipeline. When I worked at the American Medical Association (AMA) in the late 1980’s, there was a proposal to enter all health care professionals (RNs, LPNs, CNAs, allied health practitioners, etc,) into a database to track them and to identify those who were convicted of crimes or had been involved in lawsuits. At the time, the request was a mind-boggling, Mission Impossible proposal. The Internet was used only by the government and universities. Computers took up entire basements of buildings. While we had progressed beyond punch cards for data entry, the work was labor intensive and there was no uniform data collection method from state to state. But even back then in the dark ages of information technology, the AMA had extensive data on physicians, much of it on paper.
Physicians, unlike other health care professionals, are tracked by the AMA from the day they graduate from medical school until the day they die (Eiler, 2006). The reasons for the tracking are multiple: millions of dollars are invested in medical education and we have an obligation to track these human resources. In addition, we need the information for labor force planning and determining where there are underserved communities. All physicians must be credentialed to have hospital privileges. Physicians are subject to much more scrutiny in their practice, whether it is their clinical judgment or resource utilization, than any other category of health care practitioner. If a physician moves to another state in an attempt to escape lawsuits or criminal charges, you can be fairly certain that information will be found in a query of the National Practitioner Data Bank (NPDB). In case you are unfamiliar with this data bank,
“The National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB) are information clearinghouses created by Congress to improve health care quality and reduce health care fraud and abuse in the U.S. The NPDB receives and discloses information related to the professional competence and conduct of physicians, dentists and, in somecases, other health care practitioners." (HRSA, 2009, p. 1)
RNs, LPNs, allied health practitioners, and health administrators are valuable human capital, too. Perhaps the time has come to revisit Mission Impossible: a practitioner database much like the one used to track physicians and dentists. I believe we have the technology available to do this. Our phones are computers, data entry has been passed along to the individual level, and the Internet is available to everyone, not just the military or researchers. In a truly client-, resident- and patient-centered society, we would want to do this to protect the public. You can help other people, get a good job, and make money. Help is wanted--but most importantly, good help, ethical help is wanted.
Sharon B. Buchbinder, RN. PhD
Professor and Chair
Department of Health Science
Sharon Buchbinder is an Adjunct Professor of Nursing at Stevenson University in the Graduate and Professional School , and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of two books from Jones & Bartlett: Introduction to Health Care Management and Career Opportunities in Health Care Management.
Here are some references if you are interested in this topic.
American Association of Colleges of Nursing (AACN). (2009, June 22). Nursing shortage fact sheet. Retrieved on September 22, 2009
ASPH. (2008, December). ASPH Policy Brief: Confronting the public health workforce crisis. Retrieved on September 22, 2009
Buchbinder, S. B. (2008, Spring). Walking the talk. AUPHA Exchange. p. 2.
Eiler, M.A. (2006, 2nd Quarter). Helping doctors help patients for 100 years: Happy birthday AMA physician masterfile. AMA Physician Credentialing Solutions, 9(2).
Health Resources Services Administration (HRSA). (2009) National Practitioner Data Bank Healthcare Integrity and Protection Data Bank. Retrieved on September 22, 2009
Health Resources Services Administration (HRSA). (2009). The practitioners’ guide to the data banks. Retrieved on September 22, 2009